This week I attended, a “Stakeholder Conference” focusing on cosmetic surgery tourism. The event was organised by the research team at the University of Leeds which is delivering the ESRC funded research project, “Sun, Sea, Sand and Silicone”. The research examines two countries in detail as sources of cosmetic surgery tourists, the UK and Australia (as well as some tourists from China and Japan) and considers a number of popular cosmetic surgery tourism destinations including Thailand, Korea, Malaysia, Spain, Poland and Tunisia.
It was a small, invitation only event that brought together academics with some key industry interests and participants . I was asked to provide an overview of outbound UK cosmetic surgery tourism and the issues that patients and the industry face. A key topic for discussion was the issue of regulation and the rights of patients where cosmetic surgery goes wrong.
Intuition’s role through sites such as Treatment Abroad is to enable patients to make an informed choice of cosmetic surgery destination, agency, clinic or surgeon. But the choice for the patient is becoming even harder. Nowadays, they are spoiled for choice… a multitude of destinations, agencies and clinics offer what appears to be the same thing… cosmetic surgery on the cheap. There is little differentiation between providers. The patient who is searching the web for information on cosmetic surgery abroad wants answers to some basic questions about agencies, clinics and surgeons, such as:
What experience do they have?
Is the surgeon any good?
Is it safe?
Will I understand them?
What happens if it goes wrong?
Can I get my money back, if I change my mind?
But the reality is that this information is not easy to obtain, or vague answers are provided to the questions.
Cosmetic surgery abroad: Comparing quality?
Each year, in the Treatment Abroad Medical Tourism Survey, we canvas the views of patients who have travelled abroad for surgery. A large proportion (42%) of UK patients in the survey travelled for cosmetic surgery. A quarter of these went for breast augmentation; the next most popular operations were facelift, tummy tuck, liposuction and eyelid surgery. The most popular destinations for British patients were Belgium, Czech Republic, Turkey, Poland and Cyprus. When you ask patients what were the most important factors in choosing the clinic or surgeon, these three stand out: quality of doctor, quality of clinic and price. Price is (relatively) easy to compare, but how does the patient compare quality?
Areas of dissatisfaction with cosmetic surgery travel
Levels of patient satisfaction are generally lower for cosmetic surgery patients than for other types of surgery. Cosmetic surgery patients are harder to please. This is clearly reflected by the UK cosmetic patients in the Treatment Abroad Medical Tourism Survey. One in five patients expressed dissatisfaction with undergoing cosmetic surgery abroad. This is significantly higher that the dissatisfaction levels of patients who had travelled for dental, obesity and infertility treatment.
The graph shows the key areas of dissatisfaction. Here is a flavour of the responses from patients:
Dissatisfaction with doctor and clinic
“The so called Doctor was of poor quality , full of his own importance.”
“The doctor was inexperienced and a real xxxxxxxx.”
“The hospital was in fact little more than a converted house.”
Dissatisfaction with outcome
“My nipples were put in the totally wrong place.”
“I am leaking fluid and have been on antibiotics due to infection for the last 10 wks”
“I was left with a major scar”.
Dissatisfaction with aftercare
“I was asked to go home the next morning.”
“No aftercare or follow up.”
“I was not advised of after care and procedure.”
What happens when it goes wrong?
The surgeons representing British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) who attended the stakeholder event raised the issue of who deals with any problems that arise when the patient returns home. In the UK, these problems are picked up and paid for by the NHS; there has been widespread criticism of this in the media. (e.g. Should the NHS fix botched plastic surgery abroad?).
The reality is that cosmetic surgery does go wrong whether it takes place in the UK or another country. The issue for the medical tourism industry is ensuring that a patient has a route to resolution when something goes wrong. The offer of “return to our clinic and we’ll fix it for free” may not be realistic (due to the nature of the complication) or acceptable to the unhappy patient. There are now some medical travel insurance policies around which attempt to fill the gap. But few patients are aware of these or purchase them. In our survey sample, only one in ten of cosmetic surgery travellers had purchased the appropriate kind of medical travel insurance. And far fewer had purchased medical complications insurance.
The role of medical tourism agencies and facilitators
Around one third of the patients in our survey had made their arrangements through an agency or facilitator. The role of the facilitator is to aid patient choice, and ensure a safer and hassle -free patient journey. The worrying aspect of the research was that cosmetic surgery patients travelling via agencies and facilitators expressed a significantly higher level of dissatisfaction. We have to ask… where are these agencies and facilitators adding value?
It is also apparent that agencies and facilitators are becoming more like travel agents in handling the patient journey. Some are booking travel and accommodation for patients, and may well be operating as a travel agent under the UK’s Package Travel Regulations. In which case, they have clear legal obligations with regard to:
The provision of information to customers.
Financial protection and repatriation in the event of company failure.
A specific regime for contractual liability in respect of package holidays.
If in the UK, as in many other countries, there are regulations to protect consumers in the purchase of tourism services from travel agents… so, should the same or similar rules apply to those who act as medical travel agents?
The way forward
Organisations such as BAAPS, BAPRAS and ISAPS are right to be critical of cosmetic surgery tourism when the appropriate checks and balances are missing, and where the patient is clearly not being provided with the appropriate information, follow up care and support. In Europe, CEN is introducing a European Standard, “European Standard in Aesthetic Surgery Services” but this will be a standard… not a compulsory regulation. In the UK, we may see local Trading Standards Officers taking action against medical travel agents under the Package Travel Regulations.
At Treatment Abroad, we’ll continue to look for ways in which we can provide patients with the information they need to make the right choice of clinic or surgeon. But that requires clinics and surgeons to become much more open about what they do, and how they do it, and what arrangements they have in place in source countries for patients when complications (inevitably) arise).